Dermal Fillers

Dermal Fillers


Dermal fillers

Dermal fillers is a term which refers to a wide variety of different things, many of which have been used or are used to fill out lines and reshape the face.

Fat transfer was first used over one hundred years ago, and a much refined version is available today. It is still a fairly time consuming and complex procedure with a fairly high failure rate but in the right hands can give good long lasting results. Liquid paraffin and silicone have both been used in the past but caused a lot of problems and thus they are not recommended any more.

Collagen injections were first used in 1976 and are still widely used. However, collagen is derived from the skin of cattle so there is a significant demand for alternatives that are non animal sourced and longer lasting.

Products containing hyaluronic acid such as Restylane, Perlane, Juvederm, Belotero and many others have become available over the last 5-6 years and have proved highly popular. Be wary of new fillers – The regulations at present are not very demanding so a product can be promoted after minimal testing.

Results depend on:

  • The part of the face which is treated
  • How much movement there is in the treated area
  • The condition of the skin
  • The experience and skill of the person performing the treatment. (This is the most important).

Dermal fillers should be administered only by doctors and nurses. It is a simple procedure, done in the doctor’s office, and not usually requiring time off work.

Dermal fillers can be used to improve:

  • Acne scars
  • Depressions or pockmarks in the skin due to injury or disease, for example, chickenpox marks
  • Unevenness in the skin after surgery or skin grafting
  • Deep ‘smile lines’ which run from the side of the nose to the corners of the mouth
  • ‘Crows feet’ at the corner of the eyes
  • ‘Frown lines’ between the eyebrows
  • ‘Smokers lines’ which are vertical lines on the top lip
  • ‘Marionette lines’ at the corner of the mouth
  • ‘Worry lines’ which run across the forehead
  • The definition of the lip border
  • Other facial lines.

Some defects can be difficult to improve with the first treatment and although you may notice some improvement, more treatments may be needed to get best results.

Treatment with dermal fillers is not going to be successful for every person, and results and duration are variable. For some people wanting treatment for deep facial fines other treatment may be required first, followed by ‘fine tuning’ with dermal fillers.

There are now over 60 dermal fillers on the UK market. The most obvious division between them being that some are temporary and some more long lasting. The BCAM would always recommend the more temporary solutions as they do have less problems and side effects. Please ensure that the doctor explains in full his choice of filler and it’s expected duration and side effects.

Below are three of the more common treatments.

Restylane and Perlane

How does Restylane work?

Restylane adds volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). Restylane works immediately by adding volume to smooth away wrinkles. A clear gel formulation of hyaluronic acid, Restylane is specifically formulated to act like your body’s own hyaluronic acid. So, you can use Restylane to visibly reduce moderate to severe facial wrinkles and folds.

Biocompatible with the human body, Restylane is eventually broken down naturally to water and carbon dioxide.

How does Perlane work?

Just like Restylane, Perlane adds volume and fullness to the skin to correct moderate to severe facial wrinkles and folds. Like Restylane, Perlane is a clear gel formulation of hyaluronic acid that is specifically formulated to add fullness like your body’s own hyaluronic acid.

What makes Perlane different is the average size of the particles and the depth of injection. On average, the gel particles in Perlane are larger than those in Restylane, which makes Perlane a good choice for wrinkles that benefit from a deeper injection into the skin.

In three clinical studies of 150 patients each, on average 70% of patients maintained improvement for six months after just one Perlane treatment. Most patients will require a treatment roughly every 6 to 9 months.

Restylane formulations

There are 6 different formulations of Restylane for different areas and results. Restylane is available with added lignocaine to reduce injection discomfort.

    1. Restylane

Restylane has an intermediate gel particle size that makes it suitable for moderate wrinkles and lip enhancement. It is recommended that it is injected into the middle part of the dermis (middle layer of skin).

    1. Perlane
    2. Perlane has a larger gel particle size and is used for deep lines, facial contouring, and lip enhancement and is injected into the deep layer of the dermis.

    3. Restylane Touch

Touch is the smallest gel particle size in the Q-med range and is used for the correction of very thin superficial lines. It is injected into the upper part of the dermis.

    1. Restylane Lipp

Lipp has been specially designed and formulated for injecting into the lips for enhancement and contouring of thin looking lips, the cupid’s bow, or to simply add fullness. It claims to be structured to withstand the range of mouth movements and strains – like talking, smiling, laughing and kissing – that characterise the lip area and therefore the effects should last longer.

    1. Restylane SubQ

SubQ has the largest gel particle size in the range and is used to replace fat loss in the face and create or restore a more defined facial contour. The procedure requires a larger needle and deeper injections below the skin layers. This product is promoted as an alternative to fat transfer. As a result, you will find fewer practitioners who are adequately trained to use SubQ.

    1. Restylane Vital and Vital Light

Vital is aimed at a whole new approach to skin rejuvenation, using mesotherapy, (sometimes called biorevitalisation) techniques. It is targeted at a broad range of treatment areas including the face, neck, décolletage (the area between the neck and breasts) and hands; designed to replenish the hyaluronic acid lost through ageing, hence hydrating the skin and improving its elasticity and tone.

Juvéderm®

Much like Restylane Juvéderm® is available in various formats to be used in different parts of the face. These variations alter the depth of injection, the consistency and the duration of the product along with the suitable target areas.

Juvéderm® 3 and 4 are most equivalent to Restylane and Perlane and the same things described above apply.

Juvéderm® VOLUMA® is the equivalent of Restylane SubQ. Both can be used for facial volume.

Why is Facial Volume so important?

A youthful face is characterised by smooth, round contours, high cheekbones, hollow jowls and a thin, well-defined jawline. These features together comprise the “triangle of beauty” or “heart of face”, with its base at the top and summit below. As we age, facial fat loss, gravity, and loss of the skin’s natural elasticity conspire to reverse this triangle’s composition, leading to a narrower, less youthful forehead and temple area, and a wider, heavier jawline.

Juvéderm® VOLUMA® can restore the face’s balance and heart-shaped proportions, revolumising facial hollows and lost volume and recontouring the cheeks, cheekbones, and nose for a fuller, softer, more youthful appearance. Juvéderm® VOLUMA® helps recapture the facial volume that age and weight loss can diminish.

What is Juvéderm® VOLUMA®?

Juvéderm® VOLUMA® is an injectable hyaluronic volumiser that provides long-lasting restoration for facial volumes through injection. The results are immediate, even, and very natural looking.

Juvéderm® VOLUMA® restores youthful volume to cheeks, cheekbones, and chin that have become hollow or thin due to weight loss or age-related facial fat loss. It can also rejuvenate the effects of a sagging facelift.

What exactly is hyaluronic acid?

Hyaluronic acid (HA) is a naturally occurring substance found in the body that helps to hydrate and add volume to our skin. Natural hyaluronic acid is broken down by the body in one or two days so is constantly replaced. As we age this replacement mechanism diminishes so the moisturising and plumping effects of hyaluronic acid decrease. The hyaluronic acid used in Voluma® is stabilised and cross linked to achieve safe, long lasting results.

At what age should I start treatment with Juvéderm® VOLUMA®?

Juvéderm® VOLUMA® is intended for use by adults. It is the ideal implant for remodelling facial volume and correcting a receding chin.

How long will the effects of treatment with Juvéderm® VOLUMA® last?

The average effect of treatment with Juvéderm® VOLUMA® lasts about 18 months. It may sometimes be shorter or longer depending on:

  • your age
  • your physiology
  • your lifestyle (smoking and exposure to sun or UV rays may shorten the effect)
  • the amount injected and the practitioner’s technique.

Will the treatment hurt?

Most Aesthetic doctor use the latest techniques to minimise any discomfort. These can include ice packs and skin vibration. Patients do not need local anaesthetics and after the treatment any discomfort usually settles very quickly.

Why Juvéderm® VOLUMA® and not a wrinkle filler?

Juvéderm® VOLUMA® has been specifically developed to restore lost facial volume e.g. in the cheeks, cheekbones, and chin. While wrinkle fillers like Juvéderm® ULTRA offer excellent results when applied to fine lines and wrinkles around the mouth, nose, and eyes, Juvéderm® 4 and Juvéderm® VOLUMA® are often better suited to larger scale facial volumising.

When can I return to work and resume my social life?

The aesthetic results are immediate and very natural looking. You can return to work and resume your social life immediately.

Are there any side effects?

Following injection, you may experience redness, slight swelling, or bruising at the injected area. Your doctor will inform you about this. These side effects will not last and can easily be covered up with your usual makeup.

What about contraindications?

These do exist. They are not specifically related to Juvéderm® VOLUMA®, but to this type of treatment. This is why it is important to tell your doctor about any previous history of pathologies such as auto-immune diseases, allergies, known hypersensitivity to hyaluronic acid, any tendency to develop hypertrophic scars, immunotherapeutic treatment, inflammatory or infectious complaints (acne or cold sores) at injection sites, if you are pregnant or breast-feeding, any previous aesthetic treatment, particularly the use of permanent products.

Is there anything I should know before I have the treatment?

Do not take aspirin for at least three days before the injection session. During the injection, risk of bruising (haematoma) and swelling will be higher for patients under anti-coagulant treatment or taking aspirin.

Are there any recommendations I should follow after treatment?

You are advised not to apply pressure to or massage the injection site during the first days following injection session. In the first week following treatment, the injected product may feel unduly firm as it settles into the surrounding tissue. This is normal and your Voluma® will feel soft and natural just like your own fatty pads.

Sculptra® is a synthetic injectable material known as “poly-L-lactic acid.” Poly-L-lactic acid is biocompatible (a material that does not harm the body) and biodegradable (able to be broken down by the body). Poly-L-lactic acid has been widely used for many years in dissolvable stitches, soft tissue implants, and other types of implants.

How does Sculptra® work?

Sculptra® is injected below the surface of the skin in the area of fat loss. Sculptra® provides a gradual increase in skin thickness. Visible results appear within the first few treatment sessions. Sculptra® will not correct the underlying cause of the facial fat loss, but will help improve the appearance by increasing skin thickness in the treated area. No skin testing is required prior to use.

Are the results from Sculptra® immediate?

No. At your first treatment visit, it may appear that Sculptra® worked immediately because of swelling from the injections and the water used to dilute Sculptra®. In a few days, when the swelling goes down and the water is absorbed by your body, you may look as you did before your treatment. Sculptra® takes time to gradually correct the depression in your skin.

How many treatments are required?

Your Aesthetic doctor will decide the appropriate number of treatment sessions and the amount of Sculptra® you will need at each session (average 4 to 6 vials). Patients with greater facial fat loss may require 6 to 8 vials.

How long do treatment results last?

Treatment results will differ for each person. In a clinical study, the treatment results lasted for up to 2 years after the first treatment session, in most patients. Touch-up treatments may be needed to maintain the desired effect.

Do injections of Sculptra® hurt?

As with any injection, injections with Sculptra® may be uncomfortable. This is minimised by judicious use of topical anaesthesia.

What can I expect to happen at a treatment session?

  • Your Aesthetic doctor will answer all of your questions and prepare you for the treatment
  • Anaesthesia for the treatment area will be provided
  • The area where the injections will be given will be cleaned with an antiseptic
  • Sculptra® will be injected in small amounts into the skin using a very fine needle
  • Multiple injections will be needed
  • An ice pack should be applied to the treatment area to help reduce swelling.

After the treatment session, the area should be thoroughly massaged to distribute the product evenly.

What can I expect after treatment?

Immediately following a treatment session with Sculptra®, redness, swelling, tenderness, bruising or all of these signs can happen in the treatment area. These signs usually go away in a few hours to a few days, but occasionally last longer. You should massage the treated area (a few times each day) for several days after the treatment session and an ice pack may be applied for a few minutes at a time to the treatment area to help reduce swelling. Avoid excessive sun and UV lamp exposure until any initial swelling and redness has resolved.

Most patients feel comfortable going back to their normal activities following treatment. Make-up may be applied a few hours after treatment if no complications are present (for example, open wounds or bleeding).

What are the possible side effects of treatment with Sculptra®?

The most common side effects with the use of Sculptra® include injection-related side effects at the site of the injection such as bleeding, tenderness or pain, redness, bruising, or swelling. These side effects generally last, on average, 3 to 17 days.

Possible delayed side effect with Sculptra® can be small bumps under the skin in the treated area. These small bumps may not be visible, and you may notice them only when you press on the treated skin. These bumps tend to happen within the first 6 to 12 months after the first treatment.

Occasionally, these bumps go away on their own. Visible bumps, sometimes with redness or colour change to the treated area, have also been reported. As with all procedures that involve an injection through the skin, there is a risk of infection.

Questions you should ask your doctor prior to any dermal filler treatment.

  1. What are your qualifications? (the BCAM would always recommend an experienced doctor for your treatment)
  2. How long have you been doing fillers?
  3. How many patients have you treated?
  4. Which fillers do you use and why?
  5. Are there any alternatives that I should consider?
  6. How often have your patients had “problems”?
  7. Is the is filler dangerous?
  8. What problems can occur?
  9. Do you audit your results and patient satisfaction?
  10. What do I do if there is a problem with my treatment?
  11. Do you routinely follow up the result?
  12. Do you have any patients who you have previously treated whom I could speak to?
  13. How much does it cost? (this is the least important question).